丙戊酸钠血药浓度与儿童癫痫疗效的相关性研究

Correlation Between Serum Concentration of Sodium Valproate and Its Efficacy on Pediatric Epilepsy

目的探讨丙戊酸钠血药浓度对癫痫患儿疗效的影响。方法随机选择302例癫痫患儿,均给予丙戊酸钠,其中单独用药216例,其余患儿联用卡马西平、氯硝西泮等,观察并对比联合用药和单独用药时丙戊酸钠血药浓度与临床效果的关系,并记录不良反应的发生情况。结果患儿年龄越小,丙戊酸钠血药浓度达到有效浓度的概率越低,小于3岁的患儿中有42.86%低于有效血药浓度,差异有统计学意义（P〈0.05）;血药浓度达50~100 mg/L时,单独应用丙戊酸钠疗效好,差异有统计学意义（P〈0.05）;不良反应发生率随血药浓度的上升而升高,与低浓度相比,差异有统计学意义（P〈0.05）;在联合用药中,卡马西平和苯巴比妥等药会降低丙戊酸钠的血药浓度,与单独用药相比,差异有统计学意义（P〈0.05）。结论丙戊酸钠治疗癫痫患儿安全性较高,在治疗过程中需积极监测血药浓度。

Objective To analyze the efficacy of different serum concentration of sodium valproate on pediatric epilepsy. Methods 302 cases of children with pediatric epilepsy were randomly selected and given sodium valproate. 216 cases of them only used sodium valproate,and the other patients were combined with carbamazepine and clonazepam. The clinical efficacy of different serum concentration of sodium valproate were observed and compared,and the occurrence of adverse reactions after treatment was recorded. Results The probability of reaching effective serum concentration of sodium valproate lowered with younger age. 42. 86% of the patients less than 3 years old were below effective serum concentration,the difference had statistical significance（ P 0. 05）. When the serum concentration of sodium valproate was between 50- 100 mg / L,the single medication had very good clinical efficacy,the difference had statistical significance（ P 0. 05）. The incidence of adverse reactions was higher with the rise of serum concentration,the difference had statistical significance compound with low serum concentration（ P 0. 05）. In drug combination,carbamazepine and phenobarbital reduced the serum concentration of sodium valproate,which had statistically significance compound with single medication（ P 0. 05）. Conclusion Sodium valproate for treating pediatric epilepsy has high safety,and it is necessary to monitor the serum drug concentration during treatment.